Spinal Stenosis or Hip Osteoarthritis?

There are often subjective complaints in patients with lumbar spinal stenosis and hip arthritis. The signs and symptoms are very similar and can be difficult to diagnose for physicians, which is why I believe it's so important to listen to patients and their predominant pain generators. For example, a patient presented left buttock and anterior thigh pain for 1-3 years. The patient was referred to the spine clinic for a lumbar decompression surgery. However, further examination revealed that their typical pain was reproduced with internal and external rotation of the left hip. The symptoms were from hip pain the whole time, not back pain, and it would have most likely gone unnoticed without a thorough examination.

Let me share some shocking statistics with you about back pain and hip pain:

-hip osteoarthritis is seen in 27% of people over the age of 45

-85% of people will experience back pain in their lifetime

-40% will experience sciatica

-low back pain disability claims are currently in epidemic proportions

-lumbar spinal stenosis is the most frequent reason for spine surgery in patients over the age of 65

The definition of lumbar spinal stenosis is “an incongruity between the capacity and the contents of the spinal canal that may give rise to compression of the nerve roots of the spinal cord.” The common complaints that patients present with spinal stenosis are the following:

- “rubbery legs”

- “numbness in legs or pins and needles”

- “I can’t walk very far anymore”

- “I have to sit down to get rid of my hip and leg pain”

- “I have to lean on a grocery cart”

It can be confusing and complicated for patients, because these are also extremely similar symptoms for something called Hip-Spine Syndrome. Which is subjective pain in the buttock, thigh, groan, and sometimes knee. Hip-Spine Syndrome can be simple to diagnose if there is only one clear source of disability. However, it can be complex if there are coexisting pathologies but no clear source of disability. On top of this, there are other similar pain symptoms with Flat Back Syndrome and even SI Joint pain. As a physician, it’s important to me to spend quality time with my patients and exhausting all options to get to the root cause of their symptoms, then make a conjoined decision with them on the best treatment options.

Author

Dr. Kenneth Nwosu As a spine surgeon specializing in neck and lower back pain, Kenneth Nwosu, MD, is skilled in the cutting-edge techniques to address chronic pain and mobility issues caused by underlying spinal disease or injury. Dr. Nwosu believes in the many benefits that minimally invasive surgical techniques can offer his patients, including minimal hospitalization and expedient pain relief and return to an active lifestyle. He offers a variety of surgical options at his multidisciplinary spine practices in Burien and Puyallup, Washington.